Identifying unmet needs of older adults transitioning from home health care to independence at home: A qualitative study.
Ayomide Okanlawon Bankole, Tyra Girdwood, Jennifer Leeman and 2 others
PMID 37031581WHAT IT FOUND
Home health patients and caregivers described unmet needs after discharge: low engagement in planning, difficulty accessing community services, and gaps in education for chronic illness and dementia.
Clinicians reported limited awareness of these barriers.
Key findings
01Low engagement in care planning was reported as a risk for preventable health events after home health discharge.
02Limited continuity of care was reported to restrict patient and caregiver access to community-based services.
03Gaps in patient and caregiver education were reported to influence independent care of chronic illnesses after discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Findings come from one Medicare-certified home health agency in one Southeastern US state, so they may not apply to other agencies or regions. The sample was small, and three enrolled patient-clinician pairs did not complete interviews. Most patients lived with a spouse or caregiver, so the study says little about patients who live alone. Interviews happened within two weeks of discharge, so later needs and events may have been missed. Participants may have answered in a way they thought would please the research team. The study did not test transitional care interventions, so it cannot show that any recommended change improves outcomes.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read these themes as proof that any transitional care change prevents readmission or injury. The study reported experiences from one agency, and interviews happened within two weeks of discharge.